It's all Greek to me especially the 'donut hole'. Dumb question: you get a certain amount of script coverage with Medicare B then nothing for basically the rest of the year. What amount is covered? Seems like there's a whole alphabet. .... is there a simple site that clearly ealxplains it in bullet format?
Here, I just got a quote. There's
18 bullets at the bottom:
2018 Plans
Showing 3 plans
Basic Blue Rx (PDP), Basic Blue® Rx (PDP) (S6986-002) 17
Type of Plan Medicare Prescription Drug Plan (Part D) Deductible $0 for Tiers 1 & 2
$405 for Tiers 3-5 Doctor Office Visit
(Primary Care / Specialist)
Doesn't Apply / Doesn't Apply Prescription Drug Coverage
Yes - With standard coverage gap benefits Pharmacy Information
Out-of-Pocket Maximum
Doesn't Apply
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Compare This Plan
Monthly Cost 8
$
27.00
Blue Medicare Rx (PDP), (PDP) Standard (S5540-002)
Type of Plan Medicare Prescription Drug Plan (Part D) Deductible $0 for Tiers 1, 2
$300 for Tiers 3, 4, 5 Doctor Office Visit
(Primary Care / Specialist)
Doesn't Apply / Doesn't Apply Prescription Drug Coverage
Yes - With standard coverage gap benefits Pharmacy Information
Out-of-Pocket Maximum
Doesn't Apply
View More Plan Details
Summary of Benefits and Coverage (pdf)
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Monthly Cost 8
$
77.50
How to Enroll
Blue Medicare Rx (PDP), (PDP) Enhanced (S5540-004)
Type of Plan Medicare Prescription Drug Plan (Part D) Deductible $0 Doctor Office Visit
(Primary Care / Specialist)
Doesn't Apply / Doesn't Apply Prescription Drug Coverage
Yes - With enhanced coverage gap benefits Pharmacy Information
Out-of-Pocket Maximum
Doesn't Apply
View More Plan Details
Summary of Benefits and Coverage (pdf)
Compare This Plan
Monthly Cost 8
$
115.70
Footnotes
- Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
- A formulary applies for all plans that include Medicare prescription drug coverage.
- Preventive care is covered at 100% with your primary care provider, at a county health clinic, or at CVS Minute Clinics.
- You must use the plan's providers except in emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor Blue Cross NC will be responsible for the costs.
- Beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.
- Mail order is available; please see Summary of Benefits for more details.
- With the exception of emergency or urgent care, member liability with Blue Medicare PPO may be greater for services received out-of-network than services received in-network. Many out-of- network services are subject to coinsurance, which are based on the Medicare allowed amount and not on the potentially lower in-network contract amount.
- You must continue to pay the Medicare Part B premium in addition to your plan premium.
- Caution: Policy benefits are limited to those approved by Medicare for payment.
- If you go to a physician not participating in Medicare you may be responsible for the difference in the approved Medicare charge and the billed amount. Private contracts between you and a provider are excluded from Medicare and Medicare Supplemental payments.
- When you enroll in an attained-age plan, your rates will increase as you age. Our rates will only increase due to age when you move from one age band to the next. In addition, rate adjustments will also be due to medical inflation or overall claims experience. Rates are subject to change June 1 of each year and are guaranteed for 12 months. Any change in rate will be preceded by a 30-day notice. Members will not be singled out for premium increases based on their individual health. Medicare policies that are attained-age should be compared to issue-age rated policies. Premiums for issue-age policies do not increase due to age as the insured ages.
- The Silver&Fit® program is a value-added service that is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH) to members of Blue Cross NC's Blue Medicare Supplement plans. The program is not part of a member's policy or benefits, and is not available on our Plan F-HD. The program may be changed or discontinued at any time. Additional fees may apply and results are not guaranteed. You should consult with your doctor before taking part in a fitness program. All programs and services are not available in all areas. Silver&Fit and the Silver&Fit logo are trademarks of ASH and are used with permission herein. Not connected with or endorsed by the U.S. government or the federal Medicare program.
- This is only a summary of benefits describing the policies' most important features. The policy is the insurance contract. You must read the policy itself to understand all the rights and duties of both you and your insurance company. These policies may not fully cover all of your medical costs. Neither Blue Cross NC nor its agents are affiliated with Medicare. Plan A: BMS A, 11/13; Plan B: BMS B, 11/13; Plan C: BMS C, 11/13; Plan D: BMS D, 11/13; Plan F: BMS F, 11/13; Plan High-Ded F: BMS HDF, 11/13; Plan G: BMS G, 11/13; Plan K: BMS K, 11/13; Plan L: BMS L, 11/13; Plan M: BMS M, 11/13; Plan N: BMS N, 11/13.
- If you enroll within 30 days following your 65th birthday, or if you have 6 months of continuous prior coverage, the 6-month waiting period for pre-existing conditions will be waived. Pre-existing conditions are conditions for which medical advice was given, or treatment was recommended by or received from a physician within six months before the effective date of coverage. If you wait until after the deadline to enroll, you may have a waiting period for pre-existing conditions and may have to complete a medical questionnaire.
- Except the Blue Medicare HMO Medical Only plan, which does not provide drug coverage.
- Blue Cross NC is one of the World's Most Ethical Companies (2012, 2013, 2014, 2016). Ethisphere Institute reviewed nominations from companies in more than 100 countries and 36 industries.
- Basic Blue® Rx (PDP) (S6986-002) only
MII Life, Inc., a Medicare contractor, is an independent licensee of the Blue Cross® and Blue Shield® Association and the underwriter for Basic Blue® Rx, a prescription drug plan. Enrollment in Basic Blue Rx depends on contract renewal. Each Blue Cross and/or Blue Shield plan is an independent licensee of the Blue Cross and Blue Shield Association. Medicare beneficiaries may also enroll in Basic Blue® Rx through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Drug pricing information on this website is intended as an educational tool and is not a promise as to the price we will offer in the future. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply. This information is not a complete description of benefits. Contact the plan for more information. Other are available in our network. Medicare has neither reviewed nor endorsed this information. For a variety of reasons (e.g., because you visit an out-of-network pharmacy), actual pricing may vary. You must continue to pay your Medicare Part B premium. This is not a complete list of drugs covered by our plan. For a complete listing, please call TTY 1-877-376-2185 TTY 711 or visit www.basicbluerx.com The formulary and pharmacy network may change at any time. You will receive notice when necessary. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.S6986_092818_B01_NC Approved 10/10/17
- Out-of-network/non-contracted providers are under no obligation to treat Blue Cross NC members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.